Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $108.37 / $152.62 / $237.11	Professional		$108.37	$152.62	$237.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.78 / $47.85 / $156.19	Professional	26	$35.78	$47.85	$156.19
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $604.69 / $604.69 / $604.69	Professional	50	$604.69	$604.69	$604.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $69.69 / $94.50 / $131.59	Professional	TC	$69.69	$94.50	$131.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $143.50 / $334.99 / $450.27	Professional		$143.50	$334.99	$450.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.47 / $104.10 / $153.93	Professional	26	$43.47	$104.10	$153.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $87.77 / $247.75 / $309.69	Professional	TC	$87.77	$247.75	$309.69
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $136.90 / $203.37 / $338.01	Professional		$136.90	$203.37	$338.01
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.46 / $61.95 / $126.09	Professional	26	$38.46	$61.95	$126.09
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $77.08 / $133.19 / $212.57	Professional	TC	$77.08	$133.19	$212.57
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $214.20 / $214.20 / $214.20	Facility	26	$214.20	$214.20	$214.20
Medica Facility/Professional Professional Modifier Low / Median / High Price $117.70 / $205.97 / $834.21	Professional		$117.70	$205.97	$834.21
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $46.51 / $84.56 / $261.89	Professional	26	$46.51	$84.56	$261.89
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $61.71 / $116.04 / $595.82	Professional	TC	$61.71	$116.04	$595.82
Midlands Facility/Professional Professional Modifier Low / Median / High Price $151.00 / $222.85 / $392.90	Professional		$151.00	$222.85	$392.90
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $211.50 / $211.50 / $380.60	Professional		$211.50	$211.50	$380.60
United Facility/Professional Professional Modifier Low / Median / High Price $105.74 / $155.86 / $289.33	Professional		$105.74	$155.86	$289.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.03 / $63.42 / $114.70	Professional	26	$44.03	$63.42	$114.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.71 / $86.08 / $151.78	Professional	TC	$61.71	$86.08	$151.78
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $229.81 / $290.89 / $342.20	Professional		$229.81	$290.89	$342.20
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $60.83 / $77.00 / $90.60	Professional	26	$60.83	$77.00	$90.60
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $168.90 / $213.80 / $251.60	Professional	TC	$168.90	$213.80	$251.60